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TKR Sciatica Pain

karen5177

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Hello,
I am 64 years old and a widow as my husband passed away 17 years ago from multiple myeloma.
I had a left TKR on 7/16/19. I stayed one night in the hospital and everything went well. I live alone and have been on my own since the day I came home from the hospital. Friends and family stop by but I have completely taken care of myself, as I wish to. I have been very active all of my life and this surgery has been my first ever. I experienced a lot of pain the first week but things continued to improve as time went on. I have been in PT now for 5 weeks. Flexion is 115 degrees and extension 5 degrees, although down to zero with PT pushing knee. I have been happy with my progress, as have been my doctors and PT, until week 5. I now have debilitating sciatica pain running from my lower back down the outside of my leg and on the inside of my knee through to my left foot. My PT believes L4 and L5 are compressed and has me stretching before even attempting knee exercises. My surgical PA said that a few patients present with sciatica pain after surgery.
My PCP has prescribed Gabapentin 3x a day but I hate to become dependent on that. I am so afraid it will not go away. This is honestly worse than the knee pain currently and very discouraging. Has anyone had a similar experience? Many thanks!
 

WendyEL

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Hi Karen. I had a right TKR on July 15th, so we're on the same timeline and like you I also am experiencing sciatica. It has been very painful from weeks 4-6, but last week I had a massage and for the first time I had 2 days of relief. It's back again, I think I caused it by riding the stationary bike since I have to tilt my toe way down and I think i'm throwing my hip forward to pedal. I've stopped riding the bike again and am back to laying low, icing and doing less. I started back to work this week too, so I'm sure that's related as well.

I feel like more of my PT time is spent stretching/massaging my hip and hamstrings than helping the knee, though I know it's all related, but it's been a real drag. It's annoying but not awful during the day unless I have to sit for a while, but is really painful at night since it seems to flare up when I roll onto my side. I'm still not sleeping very well, 2-3 hours at a time before I'm up for an hour or two. When it first started and was most painful, I took gabapentin a few times but I didn't like how it made me feel (it was like having a bad hangover my head was so fuzzy), so now I take a muscle relaxant and advil at night but I do wish I had other alternatives to help me sleep better.

Is there any way you can get a massage? The guy I went to did a very active massage where he was pushing on my hip while telling me to stretch my arm above my head and push my leg back as far as I could. It was mildly painful at times, but I feel like he got down deep into my hip, glutes and hamstrings, and it worked for a few days! I'll be curious what ideas others have, I'll try anything!
 

Jockette

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Hi @karen5177 Welcome!

I’m sorry about your sciatica pain. Here’s an article from the Bonesmart Library:
https://bonesmart.org/forum/threads/sciatic-nerve-pain.3889/

And hi to you, also, @WendyEL you might also find that article helpful, it pretty much says what you did. How about starting a Recovery Thread so we can follow your journey with you.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)
don't overwork.
3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​
4. PT or exercise can be useful BUT take note of these
5. At week 4 and after you should follow this
6. Access to these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?

Energy drain for TKRs

Elevation is the key

Ice to control pain and swelling

Heel slides and how to do them properly

Chart representation of TKR recovery

Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.
 

jeffjob

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Karen;

I just had both my TKR’s done this year and I had a bout with sciatica pain. Mine was caused by my walking being different by the new knee. It lasted 2-3 weeks and then went away on its own.

Walking on the new knees is a learn8ng curve and I found it caused a few issues.
 

luvcats

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I woke from this latest surgery with right side sciatica. I'm pretty annoyed about it. I have this problem on and off and mine can usually be resolved with a visit to my chiropractor. I even went to see him the week before surgery specifically so I wouldn't have any issues like this. I expect it has to do with being man-handled during surgery for me. It's really annoying. My prescribed pain meds aren't really taking care of it. If I were at 5 weeks, I'd be getting myself an appointment asap. I have had luck before with massage too.

I hope you find a solution that works for you soon.
 
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K

karen5177

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Thank you so much to all for taking the time to respond! Wendy questioned as to whether hers started with riding the stationary bike. Interestingly enough, I realize that is when mine started also. I pushed it hard and in doing so did extend my leg. I appreciate the information and believe it makes sense. Also, as mentioned, walking is still somewhat challenging. My surgery leg actually feels like it is a different length than my other, even though I know it isn't. I will make an appointment for a massage and perhaps a chiropractor. Thank you for your responses. My best to all!
 

LindaO

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I have had issues with sciatica pain off and on for several years. When they did my Rt TKR initially, I had bad sciatica. Surprisingly, when he did my MUA on the right knee, the sciatica disappeared!
Previously I had PT and they performed ultrasound on my back that helped the sciatica. I then bought a home machine and when I started to have the pain, I would use the ultrasound and it would help tremendously!
I think the massage will help a lot as well and continue to stretch! I hope you are feeling better soon...that is miserable pain!!
 
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karen5177

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Thank you, Linda. I have scheduled a massage but can't get in until September 19th. Hopefully I will see good results!
 

luvcats

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I had issues feeling that my upgraded leg was longer than the other one. My PT said its referred to as a "functional difference". The upgrade side is straight and strong, and the other leg may have a bow or compression that makes it feel shorter.
 

Atlas_aus

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I just had both my TKR’s done this year and I had a bout with sciatica pain. Mine was caused by my walking being different by the new knee. It lasted 2-3 weeks and then went away on its own.

Walking on the new knees is a learn8ng curve and I found it caused a few issues.
@karen5177 I have suffered from Sciatica possibly longer than I have with my knees, though only just !!

I am about 14 weeks post BTKR and have progressed well. I have followed the mantra of this site pretty much and achieved good results. The time I did go to PT who was not aggressive at all and was well aware of my back issues had me try some exercises...

Well later that afternoon I had the worst sciatica I had in a very long time..... So we worked out anything that puts the slightest strain on my back, like laying flat and lifting straight leg was to be avoided.

It has been tolerable since. The 'funny' thing is before my surgery it was my left side for the sciatica, then post it moved to my right side and has stayed for now.

I believe having BTKR has changed the way i walk, stand etc and changes to my body in general to be expected. I know I will never be truly free of my back issues, but on a positive note I am loving my pain free knees ! Well knee joints, I am still having some pain !

My advice is to take control of your body, I am sure you know what can set the sciatica off and avoid doing those things. The knee will come good, it may take up to 1yr plus to fully recover.

Good luck.
 

WendyEL

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I'm now at week 12 and my sciatica has mostly gone away. I tried riding the stationary bike again yesterday and I feel like it's on the verge of flaring up again, ugh. Unfortunately for me I'm a mountain biker and am eager to get back to biking, but I think i'm not quite there yet.

Another thing that seemed to help was a low dose of Gabapentin. When my doc first prescribed it, he gave me 500 mg pills, and I felt like a zombie. I just happened to go to my internist for another issue, and she told me there were 100mg pills. Once I changed to those I was able to get on top of my sciatica, 200 mg was a good dose for me. Hopefully this helps someone else out there.
 

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